A Theory-based Educational Intervention to Promote Physical Activity Participation in Older Adults

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Methods The study was conducted to determine the effect of an educational intervention based on social cognitive theory (SCT) on PA among Iranian older adults. 88 elderly people referred to health centers in Isfahan in 2024 were randomly selected. 6 training sessions were conducted in the intervention group (N: 44). Questionnaires were distributed in the intervention and control groups at the immediate, 3, and 12-month follow-ups, and were analyzed by independent t-tests, RM-ANOVA, and MANCOVA. Results Immediate, three, and 12 months after the intervention, the mean scores of all the constructs including self-efficacy, social support, perceived expectations, and perceived values significantly increased in the intervention group compared to the control (P < 0.001). Three and 12 months after the intervention, the participation rate in PA improved significantly in the intervention group (P < 0.001). Conclusion The findings suggest that interventions guided by SCT, improve older adults' PA participation, which offers great potential for broader application in other settings. Social Cognitive Theory Physical Activity – Older adults Introduction Physical activity (PA) is an important component of healthy aging, and lack of PA is one of the most important causes of health problems in older adults [ 1 ]. Despite statements from the Department of Health and Human Services PA Guidelines Advisory Committee, only 28–34% of adults aged 60 and older participate in any leisure time PA [ 2 ]. Older adults with low levels of physical activity have a higher chance of mortality as compared to those with intermediate/high levels of physical activity, regardless of sociodemographic and clinical variables. Also, the lack of PA plays an important role in the occurrence of physical and mental diseases and increasing health costs [ 3 , 4 ]. One of the contributing factors to insufficient PA is the presence of various barriers that individuals encounter when attempting to engage in PA. These barriers include financial situation, lack of social support, lack of sports facilities, and concerns regarding neighborhood safety [ 5 ]. In addition, Mohammadi Zeidi et al. (2020) concluded in their study that psychological variables such as action self-efficacy, coping self-efficacy, outcome expectation, and risk perception play a role in performing regular PA, so their absence is also considered as an obstacle to PA [ 6 ] education emerges as a potential solution to mitigate and overcome these obstacles. Gregory et al. (2012) showed the effectiveness of educational interventions in reducing perceived barriers to PA [ 7 ]. Several health, social, or educational psychology theories have been proposed to understand health behavior change based on psychosocial processes [ 8 – 11 ]. These theories have been applied to the PA domain to identify the main constructs significantly associated with PA levels in different populations. Due to their low physical, mental, and social performance levels, older adults show less self-efficacy, expectation of results, and perceived social support than other age groups [ 12 ]. Bandura's social cognitive theory (SCT) examines the mental and social factors affecting PA behavior [ 13 ]. This theory considers human performance to result from the interaction of three sets of psychological (individual) factors, the social physical environment, and behavior, and a change in each of the three environmental, personal, and behavioral factors can cause changes in older adults [ 14 ]. This study aimed to investigate the role of an educational intervention based on SCT in increasing PA participation in older adults. Methods Study design and Participants This quantitative and semi-experimental intervention included 88 people over 60 years of age and was conducted in Isfahan City, Iran, in February 2024. The sample size was calculated using the sample size equation at the 95% confidence level (p = 0.05) [ 15 ]. The multistage stratified sampling method was used to select eligible individuals aged 60 years and older from two health centers in Isfahan City, who were selected randomly from southeastern Isfahan. The inclusion criteria were being over 60 years old, being able to communicate and interview, not suffering from acute or debilitating diseases, and having consent to participate in the study, and the exclusion criteria included reluctance to participate in the study at any time, and absence more than 2 sessions in educational classes. Signed informed consent was obtained from all research participants after orally reviewing the approved, informed consent document with the participants. Intervention Educational sessions were held in six 45-minute sessions (to increase knowledge, self-efficacy, perceived social support, outcome expectation, outcome value, and PA) for the intervention group. Educational sessions included a group discussion between the participants and expressing their views on whether PA was beneficial so that each participant would reach perceived self-efficacy. According to the four steps Bandura's self-efficacy educational sessions were held as the following steps: 1. Breaking down PA behavior into smaller steps for example muscle stretching when getting out of bed, short walks of a few minutes during the day, and doing some simple trained sport in between daily activities. 2. Discussing successful experiences in other situations in their life for example their achievements in doing other activities such as cooking, cropping plants, and doing housework. 3 Role modeling includes discussion of other older adults who do PA routinely, or well-known older adult actors who are active in daily activity. 4. Teaching stress control strategies in new circumstances such as deep breathing among PA, meditation, and yoga. The researcher also discussed participants’ outcome expectancies and outcome values through educational videos, and group discussions about the results of PA in their lives. The researcher also encouraged them to try to determine the reasons for their failure and trained them in help-seeking to do PA and doing PA with their family and friends in public places such as parks or pools (if possible). An instructor trained the participants in age-appropriate physical exercises at the end of each session. Finally, three months and one year after the intervention, the researcher completed the questionnaires for the intervention and control groups. It should be noted that after the end of the intervention, the control group was given an educational package based on the results of the intervention. Measures The data collection tool included a questionnaire consisting of three parts: demographic information; researcher-made questionnaires of self-efficacy; perceived social support; outcome expectancies; and outcome values, as well as the standard PA Scale for older adults (PASE) [ 16 ]. The demographic characteristics included the participants' age, education level, sex, number of children, marital status, income level, and job status, Participants completed the Leisure-Time, Physical Activity Questionnaire (PASE) designed by Washburn et al. in 1993 as a validated self-measure of PA [ 16 ]. In Iran, Hatami et al. confirmed the validity and reliability of the questionnaire with a Cronbach's alpha coefficient of 0.94 [ 17 ]. This questionnaire evaluates activities such as older adults’ leisure time, household and outdoor tasks, and light, moderate, and vigorous sports. It has three parts: leisure time, home activities, and job activities. The cognitive factor questionnaire used was the researcher-made questionnaire based on the SCT. A pool of items was gathered according to the literature review, and expert comments [ 18 ]. A panel of 8 experts, including 5 health education experts, and 3 gerontologists, evaluated the content validity of the questionnaire in the qualitative phase. In the quantitative phase, the questionnaire was appraised regarding its content validity index (CVI) and content validity ratio (CVR). The items' clarity, simplicity, and relevance were measured in the CVI assessment (according to Lawshe, CVIs greater than 0.7 are acceptable) [ 19 ]. CVR was used to ensure that the items had been developed in the best way to measure the mentioned factors (according to Waltz & Bausell, CVRs greater than 0.75 were acceptable) [ 20 ]. To ensure face validity, the first draft of the questionnaire was evaluated by 15 older adults who were not expected to participate in this study. They informed the research team if any of the items in the questionnaire were not clear or difficult to comprehend. The research team considered the comments and feedback provided and then incorporated them where appropriate to develop the final version of the questionnaire. Finally, Cronbach’s alpha was used to examine the data's reliability (values above 0.7) [ 21 ]. The final version of the questionnaire was organized into three sections addressing different topics including: Self-efficacy was assessed with 10 questions on a 5-point Likert scale (from not sure to completely sure), (Cronbach's alpha coefficient of 0.829, ICC: 0.995) and (CVI > 0.9, CVR > 0.8), which measured older adults’ perception of their ability to do PA in a different situation. The nine-item scale assesses social support on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree) to measure older adults’ perception of family and friend support to do PA (Cronbach's alpha coefficient of 0.844, ICC: 0.989) and (CVI > 0.9, CVR > 0.8). To evaluate the outcome expectancies and values, fourteen questions were designed to assess positive and negative expected outcomes from engaging in PA, on a 5-point Likert scale (from never likely to very likely). The participants were also asked to rate the degree of importance of each possible outcome on a 5-point Likert scale (from unimportant to very important). A higher score indicates higher outcome expectations and outcome values (Cronbach's alpha coefficients of 0.827 and 0.820, respectively), (ICC: 0.988 and 0.958), and (CVI > 0.9, CVR > 0.8). Statistical analysis To describe the data, the mean, standard deviation, and frequency were used. The data were analyzed using IBM SPSS 23. The chi-square test was used for demographic variables to compare the two study groups. Independent t-tests, multivariate analysis of variance (MANCOVA), repeated-measures ANOVA, and LSD post hoc test were also used to investigate the effect of education in two groups. The significance level was considered to be 0.05 for the LSD and chi-square test and 0.001 for the other tests. Results The mean age of the participants ranged from 60–80 years (intervention group: 68.38 ± 7.76 years, control group: 69.16 ± 7.28 years). Most of the participants were married (intervention group: 77.3%, control group: 75%), retired (intervention group: 40.9%, control group: 45.5%), had an average income (intervention group: 68.2%, control group: 54.5%) and had a college education (intervention group: 43.2%, control group: 40.9%) (Table 1 ). [insert -Table 1 - here] Table 1 Sociodemographic status of participants in the intervention and control groups before the study Variable Group - N (%) Chi-square Value P value Intervention Control Marital status Married Unmarried job status Unemployed Retired Housewife employed Education status Under Diploma Diploma University Income status Average Income good income Gender Man Woman BMI Normal Overweight Obesity Age 60–69 70–79 80 and up Child status 5> 5< PA pre-test Low-level average level PA post-test low-level average level 34 (77.3) 10 (22.7) 33 (75) 11 (25) 0.06 0.50 2 (4.5) 18 (40.9) 15 (34.1) 9 (20.5) 3 (6.8) 20 (45.5) 12 (27.3) 9 (20.5) 0.63 0.88 15 (34.1) 10 (22.7) 19 (43.2) 11 (25) 15 (34.1) 18 (40.9) 1.64 0.44 30 (68.2) 14 (31.8) 24 (54.5) 20 (45.5) 1.72 0.13 22 (50) 22 (50) 22 (50) 22 (50) 0.00 1 12 (27.3) 18 (40.9) 14 (31.8) 8 (18.2) 25 (56.8) 11 (25) 2.30 0.31 30 (68.2) 9 (20.5) 5 (11.4) 23 (52.3) 18 (40.9) 3 (6.80) 0.10 0.25 27 (61.4) 17 (38.6) 26 (59.1) 18 (40.9) 0.50 0.47 38 (86.4) 6 (13.6) 37 (84.1) 7 (15.9) 0.09 0.85 29 (65.9) 15 (34.1) 36 (81.8) 8 (18.2) 3.39 0.18 The results of repeated measures analysis of variance showed the effect of time, group, and time. Group mean of PA, self-efficacy, social support, outcome expectations, and outcome value in the 3-month and one-year follow-ups was significantly increased in the intervention group(p < 0.001), but it didn’t differ in the control group (Table 2 ). Table 2 Comparison of means (SDs) of PA and SCT scores between two groups, before, three months, and one year after the intervention Variable group before After Follow up P-time P-intervention P-interaction Physical Activity intervention 118.12(72.04) 158.59(94.61) 160.44(94.53) < 0.001*** < 0.001*** < 0.001*** Control 118.91(74.76) 118.92(74.85) 118.22(74.27) 0.207*** P 0.960* < 0.001** < 0.001** Self-efficacy intervention 26.11(8.80) 35.84(7.47) 36.50(7.45) < 0.001*** < 0.001*** < 0.001*** Control 27.34(7.63) 27.68(7.30) 27.89(7.41) 0.012*** P 0.487* < 0.001** < 0.001** Social support intervention 17.82(5.28) 23.23(5.49) 23.34(5.01) < 0.001*** < 0.001*** < 0.001*** Control 18.86(5.47) 18.82(5.46) 18.73(5.06) 0.603*** P 0.364* < 0.001** < 0.001** Outcome Expectations intervention 45.98(11.04) 56.14(5.59) 57.00(5.55) < 0.001*** < 0.001*** < 0.001*** Control 46.70(11.34) 46.50(10.89) 46.68(10.81) 0.406*** P 0.761* < 0.001** < 0.001** Outcome Value intervention 47.66(12.33) 57.25(5.43) 57.89(5.30) < 0.001*** < 0.001*** < 0.001*** Control 47.25 ± 8.27 47.48(7.99) 47.32(7.91) 0.657*** P 0.855* < 0.001** < 0.001** * Calculated using an independent t−test . ** Calculated using the independent MANCOVA test . *** Calculated using a repeated−measures ANOVA According to the results, the LSD test was used to identify significant changes in the mean scores of the variables in three stages (pre-test, post-test, and follow-up) in the intervention group. The results show a significant increase in PA scores, self-efficacy, outcome expectations, and outcome value between all three stages (p > 0.05). Significant and incremental changes were observed between the mean scores of self-efficacy variables, social support, and outcome value in the pre-test and post-test and pre-test and follow-up stages (p > 0.05). These changes were not significantly observed between the post-test and follow-up stages of the mean scores of social supports (p = 0.643). [insert -Table 2- here] Discussion This study proposed a research model to examine the effectiveness of cognitive factors based on SCT in PA behavior in older adults. The results revealed the effect of educational programs in increasing the cognitive factors including self-efficacy, social support, perceived expectations, and perceived values significantly in the intervention group compared to the control group, and also increasing in outcome variable (PA) among Iranian older adults. The results clarify the relationship between SCT cognitive variables and PA and show that interventions that target multiple SCT cognitive variables can increase the PA levels of older adults. Therefore, improving the capacity of interventions to produce sustainable changes in PA is an urgent health priority and an important strategy for managing the lack of PA in individuals aged 60 years and older. These results are consistent with the findings of studies by Ayotte et al. in 2010 and Anderson-Bill et al. in 2011 [ 22 , 23 ]. However, in the study of Kinmonth et al., during the 6-month and one-year evaluations, education did not affect increasing the amount of PA [ 24 ]. The results clarify the relationship between SCT cognitive variables and PA and show that interventions that target multiple SCT cognitive variables can increase the PA levels of older adults [ 25 ]. The results showed that the mean scores of self-efficacy in the intervention group increased significantly in the 3-month and one-year evaluations after the intervention program. Increasing self-efficacy can be beneficial for increasing the amount of PA because, according to Bandura, self-efficacy is the pivotal construct within SCT and is suggested to have a direct effect on behavior as well as indirect effects through all other model components [ 26 ]. Those with high efficacy are expected to achieve favorable outcomes. Those with low efficacy expect their efforts to lead to poor outcomes. Higher self-efficacy leads to greater perceived support. People with low efficacy are easily convinced of the futility of effort in the face of difficulties [ 15 ]. Other findings also confirm the results of this study and the above facts and show that the increase or manipulation of self-efficacy increases the level of PA or adherence and maintenance of PA behavior [ 27 , 28 ]. Also, the effect of the educational intervention on increasing the social support scores in the intervention group compared to the control group can be seen in the post-test and follow-up 1 year later compared to the pre-test. Social support during early periods of changes and maintenance of PA behavior increases long-term success. In addition, the impact of social support will depend on its nature. Converging evidence across diverse spheres of functioning reveals that social support has beneficial effects only if it raises people’s beliefs about its efficacy in managing their life circumstances [ 19 ]. However, improved activity outcomes can come from programs and interventions that increase PA opportunities, by bolstering social support [ 28 ]. However, in Howell's study, social support was not significantly associated with PA for older adults [ 29 ]. Hillsdon, and Wójcicki, in their studies, declared that Higher expectations and outcome values are related to greater PA participation [ 30 , 31 ]. The expectations and outcome values related to PA participation depend on the population of interest [ 32 ]. In our study in line with Hillsdon, Son, and Wójcicki, outcome expectancies, and values were significantly increased in the educational program and positively correlated with PA. A possible explanation for the more prominent effect of PA, outcome expectancy, and outcome value in older adults may be that older adults typically have more health problems, so the health benefits of doing PA are more important to them than to younger adults. They increase their PA because of the expectation of obtaining health benefits [ 33 ]. The positive effect of training on the significant and increasing change (P-intervention < 0.001) of the average scores of self-efficacy, social support, expectations, and outcome value, and finally PA in the intervention group compared to the control during three periods (pre-test, post-test, and follow-up) (p-time < 0.001) is evident in this study. Also, in the case of PA, outcome expectation, and outcome value, there are significant changes between all 3 stages (pre-test, post-test, and follow-up) in contrast to social support (between pre-test and follow-up). A possible explanation for the more prominent effect of PA, outcome expectancy, and outcome value in older adults may be that older adults typically have more health problems, so the health benefits of doing PA are more important to them than to younger adults. They increase their PA due to higher outcome expectations, and obtaining health benefits from PA outcome expectations increases the value of the outcome [ 33 ]. An incremental and significant trend in the mean of self-efficacy, social support, outcome expectations, and outcome value, and finally, PA in the intervention group compared to the control during three times) was bright in this study(p-time < 0.001). Regarding self-efficacy, an intervention study found that during a 6-month structured program, individuals who frequently experienced more positive PA increased their self-efficacy at the end of the program, leading to higher levels of PA participation. According to McAuley individuals with higher PA self-efficacy are more likely to expect positive outcomes from PA and are more likely to enjoy PA [ 14 , 34 ]. Eventually, the implications of these findings suggest that to increase the level of participation of older adults in PA, it is important to develop intervention programs tailored to individual needs and to consider cognitive differences (SCT), especially self-efficacy characteristics. Therefore, this study, as a source of guidance, for providing information on the outcomes of PA educational interventions for older adults based on SCT theory, may help program managers and educators stop the current trend of declining participation in PA. Conclusion Increasing PA was associated with increasing cognitive variables, especially self-efficacy. Focused public policies and designing interventions in different populations are needed to confirm our findings. Research limitations we can mention the relatively limited sample size. The use of a self-report questionnaire as an information-gathering tool may have increased the probability of unreal responses among participants, especially questions related to the maintenance of behavior. Declarations Author Contributions All authors contributed to the study's conception and design. Author Contributions: Z.M. substantially contributed to the acquisition of the data, performed the data analysis, and wrote the article. M. J.T. contributed to the analysis and interpretation of the data. Z. F. D. contributed to the study's conception and design and revised the article critically for important intellectual content. Declarations of interest Funding This article is the result of a master's thesis in the field of health education and health promotion. Transparency statement The corresponding author, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Conflict of interest statement The authors declare no conflicts of interest. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethical approval and consent to participate All procedures were carried out by the ethical standards of the Helsinki Declaration of 2013, and approved by the Ethics Committee of the Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1401.288). Informed consent All participants provided written informed consent to participate. Statement of man and animal This study does not violate the rights of human participants Consent for publication All authors consented to the submission of this manuscript for publication. Competing interests No issues regarding the journal policies. All authors declare no competing interests. All authors approved the manuscript for submission. The content of the systematic review has not been published, or submitted for publication elsewhere. Disclosure statement The authors report that there are no competing interests to declare. References Anuar R, Imani D.R, Norlinta S.N.O. Pengaruh Latihan Fisik Terhadap Kebugaran Lansia Dalam Masa Pandemi Covid-19: Narrative Review. FISIO MU: Physiotherapy Evidence. 2021;2(2):95–106. https://doi.org/10.23917/fisiomu.v2i2.13978 Chodzko-Zajko W, Schwingel A, & Park C.H. Successful aging: the role of physical activity. American journal of lifestyle medicine. 2009; 3 (1):20–28. https://doi.org/10.1177/1559827608325456 Gomes I.C, Tavares V.D.O, Oliveira Neto L … et al. Associations between levels of physical activity and mortality in older adults: a prospective cohort study. Sport Sciences for Health. 2022;18: 1061–1070 https://doi.org/10.1007/s11332-021-00891-z Zhang J, Li B. The Association Between Direct Health Costs Related to Non-Communicable Diseases and Physical Activity in Elderly People. Journal of Prevention. 2024: 1–12. https://doi.org/10.1007/s10935-024-00808-9 Sabzmakan L, Asghari Jafarabadi M, Nikpajouh A, Bakhtari F. Determinants of Physical Activity among Patients with Cardiovascular Metabolic Risk Factors Based on the Educational Factors of PRECEDE Model: A Mixed Method Study Iranian Journal of Health Education & Health Promotion. 2016;4(1):5–19. https://doi.org/10.18869/acadpub.ihepsaj.4.1.5 Mohammadi Zeidi I, Morshedi H, Shokohi A. Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model. Nurs Open. 2020;8(1):442–452. https://doi.org/10.1002/nop2.645 Heath G.W, Parra D.C, Sarmiento O.L, Andersen L.B, Owen N, Goenka S, Montes F, Brownson R.C. Lancet Physical Activity Series Working Group. Evidence-based intervention in physical activity: lessons from around the world. Lancet. 2012;380(9838):272–81. https://doi.org/10.1016/S0140-6736(12)60816-2 Rosenstock I.M. Historical origins of the health belief model. Health Education Monographs. 1974;2(4):328–335. https://doi.org/10.1177/109019817400200403 Ajzen I. The theory of planned behavior. Organizational behavior and human decision processes. 1991;50(2): 179–211. https://doi.org/10.1016/0749-5978(91)90020-T Prochaska J.O, Diclemente C.C. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: theory, research & practice. 1982;19:276–288. https://doi.org/10.1037/h0088437 Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191 Netz Y, Shulamith R. Age difference in motivational orientation toward physical activity: in an application of social—cognitive theory. The Journal of Psychology. 2004;138(1):35–48. https://doi.org/10.3200/JRLP.138.1.35-48 McAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. Exercise and sports sciences reviews. 2000;28(2):85–88. https://pubmed.ncbi.nlm.nih.gov/10902091/ Bandura A. Health promotion by social cognitive means. Health Education & Behavior. 2004; 31(2):143–164. https://doi.org./10.1177/1090198104263660 Dehghani A.A, Karimi M, Rezaeipandari H, Jambarsang S, Rahmati Andani M. Effectiveness of Physical Activity Educational Program Based on Self-Regulatory Theory on. The Journal of Tolooebehdasht. 2021;20(6):58–72. https://doi.org/10.18502/tbj.v20i6.8958 Washburn R.A, Smith K.W, Jette A.M, Janney C.A. The Physical Activity Scale for the Elderly (PASE): development and evaluation. Journal of Clinical Epidemiology. 1993; 46(2):153–62. https://doi.org/10.1016/0895-4356(93)90053-4 Hatami O, Aghabagheri M, Kahdouei S, Nasiriani K. Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE). BMC Geriatrics. 2021; 21(1):1–9. https://doi.org/10.18502/ehj.v9i1.13107 Shirvani H, Sanaeinasab H, Tavakoli R, Saffari M, Khalaji K, Memar S. The effect of a social cognitive theory-based educational intervention on the physical activity of female adolescents. Iranian Journal of Health Education & Promotion. 2016;4(4):309–318. https://doi.org/10.18869/acadpub.ihepsaj.4.4.309 Ayre C & Scally A. J. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Measurement and evaluation in counseling and development. 2014;47(1):79–86. https://doi.org/10.1177/0748175613513808 Yaghmaie F. Content validity and its estimation. Journal of Medical Education. 2003;3(1):25–27. https://doi.org/10.22037/jme.v3i1.870 Cronbach L.J. Coefficient Alpha and the Internal Structure of Tests. Psychometrika. 1951; 16:297–334. https://doi.org/10.1007/BF02310555 Ayotte B.J, Margrett J.A, Hicks-Patrick J. Physical activity in middle-aged and young-old adults: the roles of self-efficacy, barriers, outcome expectancies, self-regulatory behaviors, and social support. Journal of Health Psychology. 2010;15(2):173–185. https://doi.org/10.1177/1359105309342283 Anderson-Bill E.S, Winett R.A, Wojcik J.R, & Williams D.M. Aging and the social cognitive determinants of physical activity behavior and behavior change: evidence from the guide to health trial. Journal of aging research. 2011; 2011:505928. https://doi.org/10.4061/2011/505928 Kinmonth A.L, Wareham N.J, Hardeman W, Sutton S, Prevost A.T, Fanshawe T, Williams K.M, Ekelund U, Spiegelhalter D, Griffin S.J. Efficacy of a theory-based behavioral intervention to increase physical activity in an at-risk group in primary care (ProActive UK): a randomized trial. The Lancet. 2008;371(9606):41–8. https://doi.org/10.1016/S0140-6736(08)60070-7 Bandura A. Social foundations of thought and action. Englewood Cliffs, NJ, 1986; 2: 23–28 pp. https://doi.org/10.4135/9781446221129.n6 Bandura A. Health promotion from the perspective of social cognitive theory. Psychology and health. 1998;13 (4):623–649. https://doi.org/10.4324/9781315080055 Sniehotta F.F, Scholz U, Schwarzer R, Fuhrmann B, Kiwus U, Völler H. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. International journal of behavioral medicine. 2005;12(4):244–55. https://doi.org/10.1207/s15327558ijbm1204_5 Dishman R.K, Motl R.W, Saunders R, Felton G, Ward D.S, Dowda M, Pate RR. Self-efficacy partially mediates the effect of a school-based physical activity intervention among adolescent girls. Preventive medicine. 2004;38(5):628–36. https://doi.org/10.1016/j.ypmed.2003.12.007 Howell B.M. Interactions between diet, physical activity, and the socio-cultural environment for older adult health in the urban subarctic. Journal of Community Health. 2020;45(2):252–263. https://doi.org/10.1007/s10900-019-00737-3 Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. The Cochrane Database of Systematic Reviews. 2005;1: CD003180.pub2. https://doi.org/10.1002/14651858.CD003180.pub2 . Wójcicki T. R, White S. M, & McAuley E. Assessing outcome expectations in older adults: The Multidimensional Outcome Expectations for Exercise Scale (MOEES). The Journals of Gerontology, Series B: Psychological Science and Social Sciences. 2009;64(1):33–40. https://doi.org/10.1093/geronb/gbn032 Son J.S, Kerstetter D.L, Mowen A.J, & Payne L.L. Global self-regulation and outcome expectations: Influences on constraint self-regulation and physical activity. Journal of Aging and Physical Activity. 2009;17(3):307–326. https://doi.org/10.1123/japa.17.3.307 Pan S.Y, Cameron C, Desmeules M, Morrison H, Craig C.L, Jiang X. Individual, social, environmental, and physical environmental correlates with physical activity among Canadians: a cross-sectional study. BMC Public Health. 2009; 16(9):1–12. https://doi.org/10.1186/1471-2458-9-21 McAuley E, Jerome G.J, Elavsky S, Marquez D.X, Ramsey S.N: Predicting long-term maintenance of physical activity in older adults. Preventive medicine. 2003;37(2):110–118. Https://doi.org/10.1016/S0091-7435(03)00089-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Feb, 2025 Read the published version in Sport Sciences for Health → Version 1 posted Editorial decision: Revision requested 23 Jan, 2025 Reviews received at journal 10 Jan, 2025 Reviewers agreed at journal 09 Jan, 2025 Reviewers invited by journal 05 Nov, 2024 Editor assigned by journal 24 Oct, 2024 Submission checks completed at journal 24 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5326845","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371856288,"identity":"9c81be96-91bb-4950-9cb3-523652d90124","order_by":0,"name":"Zahra Mardany","email":"","orcid":"","institution":"Isfahan University of Medical Sciences, Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Mardany","suffix":""},{"id":371856289,"identity":"8949e7c3-f675-4fd4-8f68-d2584e500ba3","order_by":1,"name":"Mohammad Javad Tarrahi","email":"","orcid":"","institution":"Isfahan University of Medical Sciences, Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Javad","lastName":"Tarrahi","suffix":""},{"id":371856290,"identity":"08336df3-4ec9-484e-a731-909418cb7c42","order_by":2,"name":"Zohre Fathian Dastgerdi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACZjApx8AgwdjAwFDBwGBAWAtYjzEDD1jLGWK0MMC1ACnGNiK06LbzH/vwg8FA3l66ufFz4bzD8ubszQcYflRsw6nF7DAz88weBgPDHpmDzdIztx023NlzLIGx58xtvFoYeBj+MPZIJDZI8247zLjhRo4BM2Mbfi2MfxgM7IFamn/zzjlsT5QWZh4Gg0SgljZp3obDicRoMWaWYTBI7rmR2GbNcyw9ecOZYwkH8frl/MHHjG8YDGzbZ6Q/vs1TY2274XjzwQc/KnBrAQPGf3BmM5g8gF89KqgjRfEoGAWjYBSMEAAAqYxTRFYy4BEAAAAASUVORK5CYII=","orcid":"","institution":"Isfahan University of Medical Sciences, Isfahan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zohre","middleName":"Fathian","lastName":"Dastgerdi","suffix":""}],"badges":[],"createdAt":"2024-10-24 14:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5326845/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5326845/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11332-025-01358-1","type":"published","date":"2025-02-26T15:58:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":77622603,"identity":"deab96e5-7af9-4432-b82d-5f2b9881f104","added_by":"auto","created_at":"2025-03-03 16:08:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":668893,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5326845/v1/dd40b5ed-30e3-4a36-8423-191cae0720ec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Theory-based Educational Intervention to Promote Physical Activity Participation in Older Adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhysical activity (PA) is an important component of healthy aging, and lack of PA is one of the most important causes of health problems in older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite statements from the Department of Health and Human Services PA Guidelines Advisory Committee, only 28\u0026ndash;34% of adults aged 60 and older participate in any leisure time PA [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Older adults with low levels of physical activity have a higher chance of mortality as compared to those with intermediate/high levels of physical activity, regardless of sociodemographic and clinical variables. Also, the lack of PA plays an important role in the occurrence of physical and mental diseases and increasing health costs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the contributing factors to insufficient PA is the presence of various barriers that individuals encounter when attempting to engage in PA. These barriers include financial situation, lack of social support, lack of sports facilities, and concerns regarding neighborhood safety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition, Mohammadi Zeidi et al. (2020) concluded in their study that psychological variables such as action self-efficacy, coping self-efficacy, outcome expectation, and risk perception play a role in performing regular PA, so their absence is also considered as an obstacle to PA [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] education emerges as a potential solution to mitigate and overcome these obstacles. Gregory et al. (2012) showed the effectiveness of educational interventions in reducing perceived barriers to PA [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral health, social, or educational psychology theories have been proposed to understand health behavior change based on psychosocial processes [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These theories have been applied to the PA domain to identify the main constructs significantly associated with PA levels in different populations. Due to their low physical, mental, and social performance levels, older adults show less self-efficacy, expectation of results, and perceived social support than other age groups [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Bandura's social cognitive theory (SCT) examines the mental and social factors affecting PA behavior [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This theory considers human performance to result from the interaction of three sets of psychological (individual) factors, the social physical environment, and behavior, and a change in each of the three environmental, personal, and behavioral factors can cause changes in older adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study aimed to investigate the role of an educational intervention based on SCT in increasing PA participation in older adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and Participants\u003c/h2\u003e \u003cp\u003eThis quantitative and semi-experimental intervention included 88 people over 60 years of age and was conducted in Isfahan City, Iran, in February 2024. The sample size was calculated using the sample size equation at the 95% confidence level (p\u0026thinsp;=\u0026thinsp;0.05) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The multistage stratified sampling method was used to select eligible individuals aged 60 years and older from two health centers in Isfahan City, who were selected randomly from southeastern Isfahan.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were being over 60 years old, being able to communicate and interview, not suffering from acute or debilitating diseases, and having consent to participate in the study, and the exclusion criteria included reluctance to participate in the study at any time, and absence more than 2 sessions in educational classes. Signed informed consent was obtained from all research participants after orally reviewing the approved, informed consent document with the participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eEducational sessions were held in six 45-minute sessions (to increase knowledge, self-efficacy, perceived social support, outcome expectation, outcome value, and PA) for the intervention group. Educational sessions included a group discussion between the participants and expressing their views on whether PA was beneficial so that each participant would reach perceived self-efficacy. According to the four steps Bandura's self-efficacy educational sessions were held as the following steps: 1. Breaking down PA behavior into smaller steps for example muscle stretching when getting out of bed, short walks of a few minutes during the day, and doing some simple trained sport in between daily activities. 2. Discussing successful experiences in other situations in their life for example their achievements in doing other activities such as cooking, cropping plants, and doing housework. 3 Role modeling includes discussion of other older adults who do PA routinely, or well-known older adult actors who are active in daily activity. 4. Teaching stress control strategies in new circumstances such as deep breathing among PA, meditation, and yoga. The researcher also discussed participants\u0026rsquo; outcome expectancies and outcome values through educational videos, and group discussions about the results of PA in their lives. The researcher also encouraged them to try to determine the reasons for their failure and trained them in help-seeking to do PA and doing PA with their family and friends in public places such as parks or pools (if possible). An instructor trained the participants in age-appropriate physical exercises at the end of each session. Finally, three months and one year after the intervention, the researcher completed the questionnaires for the intervention and control groups. It should be noted that after the end of the intervention, the control group was given an educational package based on the results of the intervention.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe data collection tool included a questionnaire consisting of three parts: demographic information; researcher-made questionnaires of self-efficacy; perceived social support; outcome expectancies; and outcome values, as well as the standard PA Scale for older adults (PASE) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe demographic characteristics included the participants' age, education level, sex, number of children, marital status, income level, and job status,\u003c/p\u003e \u003cp\u003eParticipants completed the Leisure-Time, Physical Activity Questionnaire (PASE) designed by Washburn et al. in 1993 as a validated self-measure of PA [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In Iran, Hatami et al. confirmed the validity and reliability of the questionnaire with a Cronbach's alpha coefficient of 0.94 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This questionnaire evaluates activities such as older adults\u0026rsquo; leisure time, household and outdoor tasks, and light, moderate, and vigorous sports. It has three parts: leisure time, home activities, and job activities.\u003c/p\u003e \u003cp\u003eThe cognitive factor questionnaire used was the researcher-made questionnaire based on the SCT. A pool of items was gathered according to the literature review, and expert comments [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A panel of 8 experts, including 5 health education experts, and 3 gerontologists, evaluated the content validity of the questionnaire in the qualitative phase. In the quantitative phase, the questionnaire was appraised regarding its content validity index (CVI) and content validity ratio (CVR). The items' clarity, simplicity, and relevance were measured in the CVI assessment (according to Lawshe, CVIs greater than 0.7 are acceptable) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. CVR was used to ensure that the items had been developed in the best way to measure the mentioned factors (according to Waltz \u0026amp; Bausell, CVRs greater than 0.75 were acceptable) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To ensure face validity, the first draft of the questionnaire was evaluated by 15 older adults who were not expected to participate in this study. They informed the research team if any of the items in the questionnaire were not clear or difficult to comprehend. The research team considered the comments and feedback provided and then incorporated them where appropriate to develop the final version of the questionnaire. Finally, Cronbach\u0026rsquo;s alpha was used to examine the data's reliability (values above 0.7) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The final version of the questionnaire was organized into three sections addressing different topics including:\u003c/p\u003e \u003cp\u003eSelf-efficacy was assessed with 10 questions on a 5-point Likert scale (from not sure to completely sure), (Cronbach's alpha coefficient of 0.829, ICC: 0.995) and (CVI\u0026thinsp;\u0026gt;\u0026thinsp;0.9, CVR\u0026thinsp;\u0026gt;\u0026thinsp;0.8), which measured older adults\u0026rsquo; perception of their ability to do PA in a different situation.\u003c/p\u003e \u003cp\u003eThe nine-item scale assesses social support on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree) to measure older adults\u0026rsquo; perception of family and friend support to do PA (Cronbach's alpha coefficient of 0.844, ICC: 0.989) and (CVI\u0026thinsp;\u0026gt;\u0026thinsp;0.9, CVR\u0026thinsp;\u0026gt;\u0026thinsp;0.8).\u003c/p\u003e \u003cp\u003eTo evaluate the outcome expectancies and values, fourteen questions were designed to assess positive and negative expected outcomes from engaging in PA, on a 5-point Likert scale (from never likely to very likely). The participants were also asked to rate the degree of importance of each possible outcome on a 5-point Likert scale (from unimportant to very important). A higher score indicates higher outcome expectations and outcome values (Cronbach's alpha coefficients of 0.827 and 0.820, respectively), (ICC: 0.988 and 0.958), and (CVI\u0026thinsp;\u0026gt;\u0026thinsp;0.9, CVR\u0026thinsp;\u0026gt;\u0026thinsp;0.8).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo describe the data, the mean, standard deviation, and frequency were used. The data were analyzed using IBM SPSS 23. The chi-square test was used for demographic variables to compare the two study groups. Independent t-tests, multivariate analysis of variance (MANCOVA), repeated-measures ANOVA, and LSD post hoc test were also used to investigate the effect of education in two groups. The significance level was considered to be 0.05 for the LSD and chi-square test and 0.001 for the other tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the participants ranged from 60\u0026ndash;80 years (intervention group: 68.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.76 years, control group: 69.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.28 years). Most of the participants were married (intervention group: 77.3%, control group: 75%), retired (intervention group: 40.9%, control group: 45.5%), had an average income (intervention group: 68.2%, control group: 54.5%) and had a college education (intervention group: 43.2%, control group: 40.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). [insert -Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e- here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic status of participants in the intervention and control groups before the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup - N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChi-square Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e Married\u003c/p\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003cp\u003e\u003cb\u003ejob status\u003c/b\u003e Unemployed\u003c/p\u003e \u003cp\u003eRetired\u003c/p\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003cp\u003eemployed\u003c/p\u003e \u003cp\u003e\u003cb\u003eEducation status\u003c/b\u003e Under Diploma\u003c/p\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003cp\u003e\u003cb\u003eIncome status\u003c/b\u003e Average Income\u003c/p\u003e \u003cp\u003egood income\u003c/p\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e Man\u003c/p\u003e \u003cp\u003eWoman\u003c/p\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e Normal\u003c/p\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003cp\u003eObesity\u003c/p\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e 60\u0026ndash;69\u003c/p\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003cp\u003e80 and up\u003c/p\u003e \u003cp\u003e\u003cb\u003eChild status\u003c/b\u003e 5\u0026gt;\u003c/p\u003e \u003cp\u003e5\u0026lt;\u003c/p\u003e \u003cp\u003e\u003cb\u003ePA pre-test\u003c/b\u003e Low-level\u003c/p\u003e \u003cp\u003eaverage level\u003c/p\u003e \u003cp\u003e\u003cb\u003ePA post-test\u003c/b\u003e low-level\u003c/p\u003e \u003cp\u003eaverage level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (77.3)\u003c/p\u003e \u003cp\u003e10 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (75)\u003c/p\u003e \u003cp\u003e11 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4.5)\u003c/p\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003cp\u003e15 (34.1)\u003c/p\u003e \u003cp\u003e9 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.8)\u003c/p\u003e \u003cp\u003e20 (45.5)\u003c/p\u003e \u003cp\u003e12 (27.3)\u003c/p\u003e \u003cp\u003e9 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (34.1)\u003c/p\u003e \u003cp\u003e10 (22.7)\u003c/p\u003e \u003cp\u003e19 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (25)\u003c/p\u003e \u003cp\u003e15 (34.1)\u003c/p\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (54.5)\u003c/p\u003e \u003cp\u003e20 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (50)\u003c/p\u003e \u003cp\u003e22 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (50)\u003c/p\u003e \u003cp\u003e22 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (27.3)\u003c/p\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (18.2)\u003c/p\u003e \u003cp\u003e25 (56.8)\u003c/p\u003e \u003cp\u003e11 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003cp\u003e9 (20.5)\u003c/p\u003e \u003cp\u003e5 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (52.3)\u003c/p\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003cp\u003e3 (6.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (61.4)\u003c/p\u003e \u003cp\u003e17 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (59.1)\u003c/p\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (86.4)\u003c/p\u003e \u003cp\u003e6 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (84.1)\u003c/p\u003e \u003cp\u003e7 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (65.9)\u003c/p\u003e \u003cp\u003e15 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (81.8)\u003c/p\u003e \u003cp\u003e8 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of repeated measures analysis of variance showed the effect of time, group, and time. Group mean of PA, self-efficacy, social support, outcome expectations, and outcome value in the 3-month and one-year follow-ups was significantly increased in the intervention group(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but it didn\u0026rsquo;t differ in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of means (SDs) of PA and SCT scores between two groups, before, three months, and one year after the intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ebefore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118.12(72.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e158.59(94.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e160.44(94.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118.91(74.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e118.92(74.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.22(74.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.207***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.960*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.11(8.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.84(7.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.50(7.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.34(7.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.68(7.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.89(7.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.487*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.82(5.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.23(5.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.34(5.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.86(5.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.82(5.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.73(5.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.603***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.364*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOutcome Expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.98(11.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.14(5.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.00(5.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.70(11.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.50(10.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.68(10.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.406***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.761*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOutcome Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.66(12.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.25(5.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.89(5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.48(7.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47.32(7.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.657***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.855*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e* Calculated using an independent t\u0026minus;test\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e** Calculated using the independent MANCOVA test\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e*** Calculated using a repeated\u0026minus;measures ANOVA\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results, the LSD test was used to identify significant changes in the mean scores of the variables in three stages (pre-test, post-test, and follow-up) in the intervention group. The results show a significant increase in PA scores, self-efficacy, outcome expectations, and outcome value between all three stages (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Significant and incremental changes were observed between the mean scores of self-efficacy variables, social support, and outcome value in the pre-test and post-test and pre-test and follow-up stages (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These changes were not significantly observed between the post-test and follow-up stages of the mean scores of social supports (p\u0026thinsp;=\u0026thinsp;0.643). [insert -Table\u0026nbsp;2- here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study proposed a research model to examine the effectiveness of cognitive factors based on SCT in PA behavior in older adults. The results revealed the effect of educational programs in increasing the cognitive factors including self-efficacy, social support, perceived expectations, and perceived values significantly in the intervention group compared to the control group, and also increasing in outcome variable (PA) among Iranian older adults.\u003c/p\u003e \u003cp\u003eThe results clarify the relationship between SCT cognitive variables and PA and show that interventions that target multiple SCT cognitive variables can increase the PA levels of older adults. Therefore, improving the capacity of interventions to produce sustainable changes in PA is an urgent health priority and an important strategy for managing the lack of PA in individuals aged 60 years and older. These results are consistent with the findings of studies by Ayotte et al. in 2010 and Anderson-Bill et al. in 2011 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, in the study of Kinmonth et al., during the 6-month and one-year evaluations, education did not affect increasing the amount of PA [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The results clarify the relationship between SCT cognitive variables and PA and show that interventions that target multiple SCT cognitive variables can increase the PA levels of older adults [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results showed that the mean scores of self-efficacy in the intervention group increased significantly in the 3-month and one-year evaluations after the intervention program. Increasing self-efficacy can be beneficial for increasing the amount of PA because, according to Bandura, self-efficacy is the pivotal construct within SCT and is suggested to have a direct effect on behavior as well as indirect effects through all other model components [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Those with high efficacy are expected to achieve favorable outcomes. Those with low efficacy expect their efforts to lead to poor outcomes. Higher self-efficacy leads to greater perceived support. People with low efficacy are easily convinced of the futility of effort in the face of difficulties [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Other findings also confirm the results of this study and the above facts and show that the increase or manipulation of self-efficacy increases the level of PA or adherence and maintenance of PA behavior [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlso, the effect of the educational intervention on increasing the social support scores in the intervention group compared to the control group can be seen in the post-test and follow-up 1 year later compared to the pre-test. Social support during early periods of changes and maintenance of PA behavior increases long-term success. In addition, the impact of social support will depend on its nature. Converging evidence across diverse spheres of functioning reveals that social support has beneficial effects only if it raises people\u0026rsquo;s beliefs about its efficacy in managing their life circumstances [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, improved activity outcomes can come from programs and interventions that increase PA opportunities, by bolstering social support [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, in Howell's study, social support was not significantly associated with PA for older adults [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHillsdon, and W\u0026oacute;jcicki, in their studies, declared that Higher expectations and outcome values are related to greater PA participation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The expectations and outcome values related to PA participation depend on the population of interest [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our study in line with Hillsdon, Son, and W\u0026oacute;jcicki, outcome expectancies, and values were significantly increased in the educational program and positively correlated with PA. A possible explanation for the more prominent effect of PA, outcome expectancy, and outcome value in older adults may be that older adults typically have more health problems, so the health benefits of doing PA are more important to them than to younger adults. They increase their PA because of the expectation of obtaining health benefits [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe positive effect of training on the significant and increasing change (P-intervention\u0026thinsp;\u0026lt;\u0026thinsp;0.001) of the average scores of self-efficacy, social support, expectations, and outcome value, and finally PA in the intervention group compared to the control during three periods (pre-test, post-test, and follow-up) (p-time\u0026thinsp;\u0026lt;\u0026thinsp;0.001) is evident in this study. Also, in the case of PA, outcome expectation, and outcome value, there are significant changes between all 3 stages (pre-test, post-test, and follow-up) in contrast to social support (between pre-test and follow-up). A possible explanation for the more prominent effect of PA, outcome expectancy, and outcome value in older adults may be that older adults typically have more health problems, so the health benefits of doing PA are more important to them than to younger adults. They increase their PA due to higher outcome expectations, and obtaining health benefits from PA outcome expectations increases the value of the outcome [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn incremental and significant trend in the mean of self-efficacy, social support, outcome expectations, and outcome value, and finally, PA in the intervention group compared to the control during three times) was bright in this study(p-time\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding self-efficacy, an intervention study found that during a 6-month structured program, individuals who frequently experienced more positive PA increased their self-efficacy at the end of the program, leading to higher levels of PA participation. According to McAuley individuals with higher PA self-efficacy are more likely to expect positive outcomes from PA and are more likely to enjoy PA [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEventually, the implications of these findings suggest that to increase the level of participation of older adults in PA, it is important to develop intervention programs tailored to individual needs and to consider cognitive differences (SCT), especially self-efficacy characteristics. Therefore, this study, as a source of guidance, for providing information on the outcomes of PA educational interventions for older adults based on SCT theory, may help program managers and educators stop the current trend of declining participation in PA.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIncreasing PA was associated with increasing cognitive variables, especially self-efficacy. Focused public policies and designing interventions in different populations are needed to confirm our findings.\u003c/p\u003e\n\u003ch3\u003eResearch limitations\u003c/h3\u003e\n\u003cp\u003ewe can mention the relatively limited sample size. The use of a self-report questionnaire as an information-gathering tool may have increased the probability of unreal responses among participants, especially questions related to the maintenance of behavior.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study\u0026apos;s conception and design.\u0026nbsp;Author Contributions:\u0026nbsp;Z.M. substantially contributed to the acquisition of the data, performed the data analysis, and wrote the article. M. J.T. contributed to the analysis and interpretation of the data. Z. F. D. contributed to the study\u0026apos;s conception and design and revised the article critically for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is the result of a master\u0026apos;s thesis in the field of health education and health promotion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTransparency statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were carried out by the ethical standards of the Helsinki Declaration of 2013, and approved by the Ethics Committee of the Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1401.288).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of man and animal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study does not violate the rights of human participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors consented to the submission of this manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo issues regarding the journal policies. All authors declare no competing interests. All authors approved the manuscript for submission. The content of the systematic review has not been published, or submitted for publication elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDisclosure statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report that there are no competing interests to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAnuar R, Imani D.R, Norlinta S.N.O. Pengaruh Latihan Fisik Terhadap Kebugaran Lansia Dalam Masa Pandemi Covid-19: Narrative Review. FISIO MU: Physiotherapy Evidence. 2021;2(2):95\u0026ndash;106.\u0026nbsp;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.23917/fisiomu.v2i2.13978\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChodzko-Zajko W, Schwingel A, \u0026amp; Park C.H. Successful aging: the role of physical activity. American journal of lifestyle medicine. 2009;\u003cem\u003e3\u003c/em\u003e(1):20\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1559827608325456\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGomes I.C, Tavares V.D.O, Oliveira Neto L \u0026hellip; et al. Associations between levels of physical activity and mortality in older adults: a prospective cohort study. Sport Sciences for Health. 2022;18: 1061\u0026ndash;1070 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11332-021-00891-z\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZhang J, Li B. The Association Between Direct Health Costs Related to Non-Communicable Diseases and Physical Activity in Elderly People. Journal of Prevention. 2024: 1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10935-024-00808-9\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSabzmakan L, Asghari Jafarabadi M, Nikpajouh A, Bakhtari F. Determinants of Physical Activity among Patients with Cardiovascular Metabolic Risk Factors Based on the Educational Factors of PRECEDE Model: A Mixed Method Study \u003cem\u003eIranian\u003c/em\u003e Journal of Health Education \u0026amp; Health Promotion. 2016;4(1):5\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18869/acadpub.ihepsaj.4.1.5\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMohammadi Zeidi I, Morshedi H, Shokohi A. Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model. Nurs Open. 2020;8(1):442\u0026ndash;452. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.645\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHeath G.W, Parra D.C, Sarmiento O.L, Andersen L.B, Owen N, Goenka S, Montes F, Brownson R.C. Lancet Physical Activity Series Working Group. Evidence-based intervention in physical activity: lessons from around the world. Lancet. 2012;380(9838):272\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(12)60816-2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRosenstock I.M. Historical origins of the health belief model. Health Education Monographs. 1974;2(4):328\u0026ndash;335. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/109019817400200403\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAjzen I. The theory of planned behavior. Organizational behavior and human decision processes. 1991;50(2): 179\u0026ndash;211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0749-5978(91)90020-T\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eProchaska J.O, Diclemente C.C. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: theory, research \u0026amp; practice. 1982;19:276\u0026ndash;288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/h0088437\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977;84(2):191\u0026ndash;215. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0033-295X.84.2.191\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNetz Y, Shulamith R. Age difference in motivational orientation toward physical activity: in an application of social\u0026mdash;cognitive theory. The Journal of Psychology. 2004;138(1):35\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3200/JRLP.138.1.35-48\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMcAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. Exercise and sports sciences reviews. 2000;28(2):85\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/10902091/\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBandura A. Health promotion by social cognitive means. Health Education \u0026amp; Behavior. 2004; 31(2):143\u0026ndash;164. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org./10.1177/1090198104263660\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDehghani A.A, Karimi M, Rezaeipandari H, Jambarsang S, Rahmati Andani M. Effectiveness of Physical Activity Educational Program Based on Self-Regulatory Theory on. The Journal of Tolooebehdasht. 2021;20(6):58\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18502/tbj.v20i6.8958\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWashburn R.A, Smith K.W, Jette A.M, Janney C.A. The Physical Activity Scale for the Elderly (PASE): development and evaluation. Journal of Clinical Epidemiology. 1993; 46(2):153\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0895-4356(93)90053-4\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHatami O, Aghabagheri M, Kahdouei S, Nasiriani K. Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE). BMC Geriatrics. 2021; 21(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18502/ehj.v9i1.13107\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eShirvani H, Sanaeinasab H, Tavakoli R, Saffari M, Khalaji K, Memar S. The effect of a social cognitive theory-based educational intervention on the physical activity of female adolescents. Iranian Journal of Health Education \u0026amp; Promotion. 2016;4(4):309\u0026ndash;318. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18869/acadpub.ihepsaj.4.4.309\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAyre C \u0026amp; Scally A. J. Critical values for Lawshe\u0026rsquo;s content validity ratio: revisiting the original methods of calculation. Measurement and evaluation in counseling and development. 2014;47(1):79\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0748175613513808\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYaghmaie F. Content validity and its estimation. Journal of Medical Education. 2003;3(1):25\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.22037/jme.v3i1.870\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCronbach L.J. Coefficient Alpha and the Internal Structure of Tests. Psychometrika. 1951; 16:297\u0026ndash;334. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/BF02310555\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAyotte B.J, Margrett J.A, Hicks-Patrick J. Physical activity in middle-aged and young-old adults: the roles of self-efficacy, barriers, outcome expectancies, self-regulatory behaviors, and social support. Journal of Health Psychology. 2010;15(2):173\u0026ndash;185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1359105309342283\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAnderson-Bill E.S, Winett R.A, Wojcik J.R, \u0026amp; Williams D.M. Aging and the social cognitive determinants of physical activity behavior and behavior change: evidence from the guide to health trial. Journal of aging research. 2011; 2011:505928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4061/2011/505928\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKinmonth A.L, Wareham N.J, Hardeman W, Sutton S, Prevost A.T, Fanshawe T, Williams K.M, Ekelund U, Spiegelhalter D, Griffin S.J. Efficacy of a theory-based behavioral intervention to increase physical activity in an at-risk group in primary care (ProActive UK): a randomized trial. The Lancet. 2008;371(9606):41\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(08)60070-7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBandura A. Social foundations of thought and action. Englewood Cliffs, NJ, 1986; 2: 23\u0026ndash;28 pp. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4135/9781446221129.n6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBandura A. Health promotion from the perspective of social cognitive theory. Psychology and health. 1998;13 (4):623\u0026ndash;649. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4324/9781315080055\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSniehotta F.F, Scholz U, Schwarzer R, Fuhrmann B, Kiwus U, V\u0026ouml;ller H. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. International journal of behavioral medicine. 2005;12(4):244\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1207/s15327558ijbm1204_5\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDishman R.K, Motl R.W, Saunders R, Felton G, Ward D.S, Dowda M, Pate RR. Self-efficacy partially mediates the effect of a school-based physical activity intervention among adolescent girls. Preventive medicine. 2004;38(5):628\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ypmed.2003.12.007\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHowell B.M. Interactions between diet, physical activity, and the socio-cultural environment for older adult health in the urban subarctic. Journal of Community Health. 2020;45(2):252\u0026ndash;263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10900-019-00737-3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. The Cochrane Database of Systematic Reviews. 2005;1: CD003180.pub2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD003180.pub2\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eW\u0026oacute;jcicki T. R, White S. M, \u0026amp; McAuley E. Assessing outcome expectations in older adults: The Multidimensional Outcome Expectations for Exercise Scale (MOEES). The Journals of Gerontology, Series B: Psychological Science and Social Sciences. 2009;64(1):33\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/geronb/gbn032\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSon J.S, Kerstetter D.L, Mowen A.J, \u0026amp; Payne L.L. Global self-regulation and outcome expectations: Influences on constraint self-regulation and physical activity. Journal of Aging and Physical Activity. 2009;17(3):307\u0026ndash;326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1123/japa.17.3.307\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePan S.Y, Cameron C, Desmeules M, Morrison H, Craig C.L, Jiang X. Individual, social, environmental, and physical environmental correlates with physical activity among Canadians: a cross-sectional study. BMC Public Health. 2009; 16(9):1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2458-9-21\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMcAuley E, Jerome G.J, Elavsky S, Marquez D.X, Ramsey S.N: Predicting long-term maintenance of physical activity in older adults. Preventive medicine. 2003;37(2):110\u0026ndash;118. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eHttps://doi.org/10.1016/S0091-7435(03)00089-6\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Social Cognitive Theory, Physical Activity – Older adults","lastPublishedDoi":"10.21203/rs.3.rs-5326845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5326845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePromoting physical activity (PA) behavior can help older adults create and maintain an active lifestyle.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted to determine the effect of an educational intervention based on social cognitive theory (SCT) on PA among Iranian older adults. 88 elderly people referred to health centers in Isfahan in 2024 were randomly selected. 6 training sessions were conducted in the intervention group (N: 44). Questionnaires were distributed in the intervention and control groups at the immediate, 3, and 12-month follow-ups, and were analyzed by independent t-tests, RM-ANOVA, and MANCOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eImmediate, three, and 12 months after the intervention, the mean scores of all the constructs including self-efficacy, social support, perceived expectations, and perceived values significantly increased in the intervention group compared to the control (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Three and 12 months after the intervention, the participation rate in PA improved significantly in the intervention group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that interventions guided by SCT, improve older adults' PA participation, which offers great potential for broader application in other settings.\u003c/p\u003e","manuscriptTitle":"A Theory-based Educational Intervention to Promote Physical Activity Participation in Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 10:20:27","doi":"10.21203/rs.3.rs-5326845/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-23T10:48:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-10T11:15:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214463077090083266912627012474130231907","date":"2025-01-09T16:56:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-05T08:00:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T03:53:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T03:53:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2024-10-24T14:43:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1e57ebf6-3fbf-48e9-b59a-e4ad4d7ef0b0","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T16:03:13+00:00","versionOfRecord":{"articleIdentity":"rs-5326845","link":"https://doi.org/10.1007/s11332-025-01358-1","journal":{"identity":"sport-sciences-for-health","isVorOnly":false,"title":"Sport Sciences for Health"},"publishedOn":"2025-02-26 15:58:16","publishedOnDateReadable":"February 26th, 2025"},"versionCreatedAt":"2024-11-05 10:20:27","video":"","vorDoi":"10.1007/s11332-025-01358-1","vorDoiUrl":"https://doi.org/10.1007/s11332-025-01358-1","workflowStages":[]},"version":"v1","identity":"rs-5326845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5326845","identity":"rs-5326845","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}